| Discount Dental | |
|
14210 Roosevelt Ave # 8 Flushing NY 11354-6046 | |
| (718) 460-6868 | |
| (718) 460-2112 |
| Full Name | Discount Dental |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 14210 Roosevelt Ave # 8, Flushing, New York |
| Authorized Official Name and Position | Jun Song (DENTIST) |
| Authorized Official Contact | 7184606868 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Discount Dental 14210 Roosevelt Ave # 8 Flushing NY 11354-6046 Ph: (718) 460-6868 | Discount Dental 14210 Roosevelt Ave # 8 Flushing NY 11354-6046 Ph: (718) 460-6868 |
| NPI Number | 1033571203 |
|---|---|
| Provider Enumeration Date | 03/25/2016 |
| Last Update Date | 03/25/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033571203 | NPI | - | NPPES |
| 02455109 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 057991 (New York) | Secondary |
| 122300000X | Dentist | 057616 (New York) | Secondary |
| 1223P0300X | Dentist - Periodontics | 048211 (New York) | Primary |
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